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Individual provider Active NPI

Nancy C O'Connor, PAC

  • Physician Assistant
  • Bangor, ME
National Provider Identifier
1740200161
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA45 Issued in ME
Practice address
992 Union St Ste 5
Bangor, ME 04401-3057
Phone
(207) 404-8100
Fax
(207) 947-0435
NPI assigned
Jul 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA45 ME Primary

Addresses

Primary practice location

992 Union St Ste 5
Bangor, ME 04401-3057

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 404-8200

Other identifiers 1

IdentifierTypeStateIssuer
296200099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060925000454 ME Practitioner - Physician Assistant 8628073665 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Penobscot Community Health CenterGroup PAC ID 0143212670, 135 clinicians

Practice addresses (Care Compare)

1012 Union St
Bangor, ME 04401-3058

1068 Union St
Bangor, ME 04401-3016
Phone (207) 404-8181

29 Schoodic Dr
Belfast, ME 04915-7246
Phone (207) 338-6900

992 Union St
Bangor, ME 04401-3057

Hospital & facility affiliations

  • Centerwell Home Health Home health agency, Bangor, ME, CCN 207045
  • Bristol Hospice - Bangor LLC Hospice, Bangor, ME, CCN 201526
  • Northern Light Maine Coast Hospital Hospital, Ellsworth, ME, CCN 200050
  • St Joseph Hospital Hospital, Bangor, ME, CCN 200001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA45MEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Maine Medical Center CurrentSince May 22, 2022 Accepting new patients
Penobscot Community Health Center CurrentSince Jun 15, 2024 Accepting new patients
Sunbury Primary Care, P.a. Physician Assistant Past Accepting new patients
Penobscot Community Health Center Past Accepting new patients

Locations

133 Corporate Dr
Ste 1
Bangor, ME 04401
Phone (207) 947-9900

992 Union St
Ste 5
Bangor, ME 04401
Phone (207) 992-2601

885 Union St
Ste 220
Bangor, ME 04401
Phone (207) 973-4702

1068 Union St
Bangor, ME 04401
Phone (207) 404-8181

489 State St
Bangor, ME 04401
Phone (207) 973-8837

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

Organizations & group practices 19

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 19

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1740200161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-404-8200",
            "fax_number": "207-947-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "992 UNION ST STE 5",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013057",
            "telephone_number": "207-404-8100",
            "fax_number": "207-947-0435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "NANCY",
        "middle_name": "C",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ME",
            "license": "PA45",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "296200099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.